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Arizona rates for HCPCS Q4214

Cellesta Cord, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $97.72 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $120.23 / $138.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $245.47 / $602.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $251.19 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $186.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89